How House Abortion Bill Could Impact Women With HIV

Double Stigmatization Exacerbates Fear, Distrust in Vulnerable Women

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The association between abortion and HIV remains strong, although it has been greatly complicated by the polarizing nature of the abortion debate in the U.S. Irrespective of which side of the issue you may stand, the simple fact is that higher rates of unintended pregnancy are reported among HIV-positive women than their non-infected counterparts.

On March 13, 2015, the U.S. House of Representatives placed the abortion debate squarely in the spotlight by passing a bill banning abortions after 20 weeks.

An earlier version of the bill, entitled the Pain-Capable Unborn Child Protection Act, had stalled when female Republicans withdrew their support after failing to secure a clause that would allow late-term abortions in cases of rape.

The newly approved House bill, if passed by the Senate, would bar women from obtaining an abortion after 20 weeks unless the pregnancy was a result of a rape or incest, or if the woman's life were in jeopardy. It would also require victims of rape to receive medical attention and counseling 48 hours before an abortion can be performed.

Additionally, there are no provisions in the bill for abortions in the event of severe fetal abnormalities. Instead physicians would be required provide lifesaving measures if there is any chance for the baby to survive outside of the womb.

Opponents to the bill argue that such a law would place excessive emotional and financial stress on women seeking abortions, while placing providers in the tenuous position of having to decide whether certain abortions are actually legal or not.

Why Would This Impact Women with HIV?

The stigma associated with abortion in the U.S. generally runs high, as evidenced by the fact that 84% of abortion providers are targeted for anti-abortion harassment each year while 53% report having been picketed at least 20 times per year.

Similarly, the stigma associated with HIV is often pervasive in at-risk communities, specifically those impacted by high levels of poverty.

Within these populations, HIV-related stigma has long been associated with lower rates of testing, as well as a three-fold decrease in the number of people accessing and remaining in HIV-specific care.

Activists argue that the intersection of these two stigmas only further disempowers women by exacerbating fears and distrust in healthcare systems, particularly when the denial of services is considered punitive. Placing barriers to abortion—even perceived ones, they argue—effectively eliminate a vital point of entry to care, including interventions meant to identify or prevent HIV.

This is especially true for low-income women. Of the estimated one million women who obtain abortions every year, 54% live 100% below the federal poverty line (FPL) while 27% live 100-199% below the FPL. Within this very same population, the rate of HIV is no less than 800% greater than those living at or above the FPL.

In fact, of those whose annual incomes are less than $10,000, the risk of HIV is 13000% greater than those with incomes of $50,000 or more.

Currently in the U.S., one in 12 women with HIV is undiagnosed. Of those who have been tested, the percentage in active care remains poor (45%) while only one in three are able to sustain viral control while on therapy. African American women considered to be at particular risk, representing nearly a quarter of the total HIV population as well as the lion’s share of all new female infections each year (64%).  

In can be reasonably argued, therefore, that any barriers to abortion—as well as the stigmatizing effects of such bans—only serves to undermine the sexual health of an already vulnerable female population, including the unimpeded access to preventive services and provisions for financial and/or treatment assistance.

The House bill is seen by many to be the first step toward a Republican dismantling of , with supporters and opponents split almost entirely along party lines. In the event that the bill is not blocked by Senate Democrats, the likelihood of it passing into law depends largely on who is elected president in 2016. Most current GOP candidates strongly support the bill.


Guttmacher Institute. "Induced Abortions in the United States." Washington, D.C.; July 2014.

Kaiser Family Foundation (KFF). "Women and HIV/AIDS in the United States." May 6, 2014.

CDC. "Communities in Crisis: Is There a Generalized HIV Epidemic in Impoverished Urban Areas of the United States? " Accessed May 19, 2015.

Ammassari, A.; Cicconi, P.; Ladisa. N.; et al. "Induced first abortion rates before and after HIV diagnosis: results of an Italian self-administered questionnaire survey carried out in 580 women living with HIV." HIV Medicine. June 25, 2012; 14(1):31-39.

The Guardian.  "Republican candidates line up behind House's 20-week abortion ban." Published online May 18, 2015.

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